Medical Director

This is a fully remote position, open to applicants in United States.

📋 Description

• Provides clinical leadership and oversight for RxBenefits' utilization management initiatives.

• Conducts medical necessity reviews for both physicians and members.

• Acts as a consulting physician for peer-to-peer discussions as necessary.

• Collaborates with and audits third-party external review organizations.

• Works alongside Legal and Compliance teams to ensure regulatory compliance.

• Serves as the Medical Director of record across multiple states.

• Engages in internal audits, compliance evaluations, and quality enhancement projects.

⛳️ Requirements

• Doctor of Medicine or Osteopathy from a recognized institution.

• An active, unrestricted medical practice license.

• Preferred multiple state licenses.

• A minimum of 5 years of professional medical experience post-residency training.

• Required experience in utilization management and prior authorization.

• Knowledge of pharmacy practices is essential; experience with specialty drug utilization is preferred.

• Strong analytical and problem-solving abilities.

• Capability to translate clinical insights into business strategies and client solutions.

• Exceptional collaboration skills with both internal and external stakeholders.

• Outstanding written, verbal, and presentation abilities.

• Proficient in Microsoft Office applications.

• Willingness to travel occasionally.

🏝️ Benefits

• Utilization Management Review

• External Review Coordination

• Utilization Management Compliance Support

• Regulatory Oversight

• Stakeholder Collaboration